Transnasal sphenopalatine nerve block for patients with headaches

Slullitel, Alexandre; Santos, Ivan S.; Machado, Felipe Chiodini; Sousa, Ângela Maria

doi:10.1016/j.jclinane.2018.03.025

Cited by 3 publications

(4 citation statements)

References 3 publications

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“…A small implantable sphenopalatine ganglion stimulator became cleared for use in Europe based on positive clinical trial data but has faltered in the United States because of regulatory and financial barriers 39-41 . Peripheral sphenopalatine ganglion blockade can be useful, although evidence is lacking and methods for performing the procedure are not uniformly accepted 42,43 . Experimental treatment with deep brain stimulation has been effective for a small number of individuals but generally is considered too dangerous to make the risk worth the benefit 44,45 …”

Section: Cluster Headachementioning

confidence: 99%

“…[39][40][41] Peripheral sphenopalatine ganglion blockade can be useful, although evidence is lacking and methods for performing the procedure are not uniformly accepted. 42,43 Experimental treatment with deep brain stimulation has been effective for a small number of individuals but generally is considered too dangerous to make the risk worth the benefit. 44,45 Physicians caring for patients with cluster headache should be aware that some of them may resort to using hallucinogens such as psylocibin and D-lysergic acid (chemically related to ergots) to treat their intractable attacks.…”

Section: Key Pointsmentioning

confidence: 99%

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Cluster Headache and Other Trigeminal Autonomic Cephalalgias

Nahas¹

2021

CONTINUUM: Lifelong Learning in Neurology

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PURPOSE OF REVIEWThe trigeminal autonomic cephalalgias (TACs) are relatively rare, but they represent a distinct set of syndromes that are important to recognize. Despite their unique features, TACs often go undiagnosed or misdiagnosed for several years, leading to unnecessary pain and suffering. A significant proportion of TAC presentations may have secondary causes.RECENT FINDINGSThe underlying pathophysiology of TACs is likely rooted in hypothalamic dysfunction and derangements in the interplay of circuitry involving trigeminovascular, trigeminocervical, trigeminoautonomic, circadian, and nociceptive systems. Recent therapeutic advancements include a better understanding of how to use older therapies more effectively and the identification of new approaches.SUMMARYTAC syndromes are rare but important to recognize because of their debilitating nature and greater likelihood for having potentially serious underlying causes. Although treatment options have remained somewhat limited, scientific inquiry is continually advancing our understanding of these syndromes and how best to manage them.

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Section: Cluster Headachementioning

confidence: 99%

Section: Key Pointsmentioning

confidence: 99%

Cluster Headache and Other Trigeminal Autonomic Cephalalgias

Nahas¹

2021

CONTINUUM: Lifelong Learning in Neurology

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“…If used in a clinically refractory patient, SPGB has the potential to relieve PDPH rapidly and may prevent the use of an invasive treatment 16 . The risks of a transnasal SPGB are mainly bleeding, and temporary discomfort 6 are significantly lower than the risks of the AEBP, which includes dural puncture, neurologic complications, bleeding, and infection 17,18 .…”

Section: Discussionmentioning

confidence: 99%

“…It can be accessed through transcutaneous or transnasal approaches. The SPGB has been successfully used in pain clinic practice to treat chronic headaches, atypical facial pain, and even trigeminal neuralgia 5,6 . The transnasal approach 7 is a noninvasive technique that can be easily performed and could be beneficial to PDPH by blocking the parasympathetic tonus at the cerebral vasculature, returning them to their normal diameter and relieving the headache with a low cost and low risks procedure 8 .…”

Section: Introductionmentioning

confidence: 99%

Sphenopalatine ganglion block for post-dural puncture headache after invasive cerebrospinal fluid pressure monitoring. Case report

Machado

Neto

Ashmawi

2019

Brazilian Journal of Pain

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BACKGROUND AND OBJECTIVES: Post-dural puncture headache is a common complication in neuraxial anesthesia and lumbar puncture diagnostic procedures. The pathogenesis of the headache is thought to be due to a leak of cerebrospinal fluid from the puncture site that exceeds the rate of cerebrospinal fluid production, causing a downward traction of the meninges and vasodilation of the meningeal vessels mediated by the autonomous nervous system. Nowadays, the conservative treatment involves hydration, and the use of caffeine, analgesics, hydrocortisone, gabapentin, and theophylline. However, an autologous epidural blood patch is considered the definitive treatment for post-dural puncture headache and has an efficacy of up to 75%. Since this procedure comes with intrinsic risks, an alternative is the sphenopalatine ganglion block. CASE REPORT: We describe a case report using a sphenopalatine ganglion block to treat post-dural puncture headache in a patient submitted to cerebrospinal fluid pressure monitoring with a subarachnoidal catheter inserted with a low-gauge needle. CONCLUSION: This is the first case report of a post-dural puncture headache caused by a subarachnoid monitoring catheter successfully treated with sphenopalatine ganglion block. This technique can be a non-invasive option in the management of post-dural puncture headache, which requires more study to evaluate its efficacy and safety.

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Transnasal Sphenopalatine Ganglion Block for Management of Postdural Puncture Headache in Non-Obstetric Patients

Takmaz¹,

Karaoğlan²,

Baltaci

et al. 2021

J Nippon Med Sch

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Background: This study investigated the efficacy and safety of transnasal sphenopalatine ganglion block (SPGB) for treatment of postural puncture headache (PDPH) in non-obstetric patients.Methods: This retrospective study was conducted at the Ankara Research and Educational Hospital, in Turkey, and included 26 non-obstetric patients (age, "18 years) who were diagnosed with PDPH and unresponsive to conservative therapy or unable to continue it because of side effects. Transnasal SPGB was performed in each nostril. Pain severity was assessed with the Visual Analogue Scale (VAS) at 15 min, 30 min, 24 h, and 48 h after the procedure, while patients were seated. The patients were monitored for 48 h for adverse effects (AEs). Patient treatment satisfaction was assessed at 48 h after the procedure by using the Patient Global Impression of Change (PGIC) scale.Results: Headache at 15 min post-procedure was relieved rapidly. At 24 h post-procedure, nearly half of patients (42.3%) had no pain, and all patients (100%) had a VAS score of <3. Nasal discomfort, throat numbness, and nausea were AEs reported after SPGB; however, these AEs were completely relieved at 24 h after the procedure. According to the PGIC scale scores at 48 h post-procedure, 73.1% of patients evaluated themselves as "much improved" and 26.9% evaluated themselves as "very much improved". Conclusion:When PDPH does not respond to conservative treatment, it may be treated effectively with transnasal SPGB, which is a noninvasive, safe, well-tolerated, and straightforward method with a low complication rate.

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Transnasal sphenopalatine nerve block for patients with headaches

Cited by 3 publications

References 3 publications

Cluster Headache and Other Trigeminal Autonomic Cephalalgias

Cluster Headache and Other Trigeminal Autonomic Cephalalgias

Sphenopalatine ganglion block for post-dural puncture headache after invasive cerebrospinal fluid pressure monitoring. Case report

Transnasal Sphenopalatine Ganglion Block for Management of Postdural Puncture Headache in Non-Obstetric Patients

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